Analysis of the occurrence of postoperative cognitive dysfunction with the use of morphine hydrochloride after hip arthroplasty under spinal anesthesia

Abstract

Purpose - to analyze the state of cognitive function of patients according to the Mini Mental State Examination (MMSE) scale in points at different follow-up periods; to establish the relationship between the occurrence of postoperative cognitive dysfunction (POCD) and a single administration of morphine hydrochloride after hip arthroplasty under spinal anaesthesia in the early postoperative period

Materials and methods. The study was conducted on the basis of the Vinnytsia City Clinical Hospital of Emergency Medical Care with the participation of 120 patients. All patients were operated on for a hip fracture - hip joint replacement under spinal anesthesia. All patients in the postoperative period were evaluated for pain intensity according to the visual analog scale (VAS). In the early postoperative period, patients received: a combination of paracetamol and dexketoprofen. In case of insufficient effectiveness of paracetamol and dexketoprofen, which was assessed as the impossibility of maintaining the pain level according to VAS no more than 4 points, morphine hydrochloride 10 mg was used. The MMSE scale was used as one of the main evaluation scales for the dynamics of POCD. In this part of the work, patients were divided into two main groups depending on the dynamics of the cognitive deficit, which was determined by the MMSE scale during the entire period of observation, which generally divided the patients into two groups: «Without negative dynamics of cognitive functions» (n=85) and «With negative dynamics of cognitive functions» (n=35). Statistical processing was carried out using StatPlus programs according to parametric and non-parametric criteria, differences were considered significant at p<0.05.

Results. On the 7^th day after hip arthroplasty, the negative dynamics of cognitive function, compared to the data during hospitalization, remained in 68.6% of patients with morphine hydrochloride among them: in 41.6% of patients, mild cognitive disorders appeared in their absence at the stage of hospitalization, in 29.2% there was a transition from mild cognitive disorders to mild dementia and in another 29.2% - mild to moderate dementia (p=0.03).

Conclusions. The obtained data indicate that 92.3% of patients who had cognitive impairment at the time of discharge from the hospital received morphine hydrochloride, which may indicate a negative effect of the use of this drug on the cognitive functions of patients with hip arthroplasty on the background of a hip fracture.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research.

No conflict of interests was declared by the authors.